Clinical Study of Gastric Carcinoma: Fifty cases

INTRODUCTION: Carcinoma Stomach is the main Gastrointestinal Malignancy encountered in surgical clinic. The importance of early diagnosis and gastric cancer cannot be overemphasised. Early Gastric cancer without lymphnode metastasis is highly curable, whereas advanced cancer is associated with a poor prognosis. By improved methods of diagnosis, the Japanese had developed mass screening programs and have significantly improved their 5 year survival statistics. In Japan 50% of gastric cancers treated are early gastric cancers. In united states about 20% of the resected specimens show Early gastric cancer. World wide especially in Asia and Eastern Europe, Gastric cancer remains the second most common among cancers and is the leading cause of cancer deaths. In India carcinoma stomach is the fourth common malignancy and second common cause of death due to malignancy. The detection of early gastric cancer is still less than 5 to 10% in India. The present study is an attempt to establish the incidence, role of risk factors, analyse the symptomatology, stage of disease, mode of various surgical treatment and results in our patients and compare them with results abroad. AIM OF THE STUDY: The aim was to study the following objectives in patients admitted with a diagnosis of Gastric Cancer, and operated in Government Kilpauk Medical College Hospital and Government Royapettah Hospital, Chennai. 1. To discuss the incidence, causative factors, mode of presentation, disease pattern of Gastric carcinoma in our patients. 2. A study of Barium meal examination, upper gastro intestinal endoscopy and computerised tomography in the diagnosis of Gastric carcinoma. 3. To discuss various surgical modalities in the management of gastric cancer. 4. To compare the results with that of world statistics. PATIENTS AND METHODS: This study was carried out on 50 patients of Gastric Carcinoma in Surgical Wards of Government Kilpauk Medical College Hospital and Government Royapettah Hospital, Chennai, during the period, June 2004 to August 2007. Initial work up included, clinical examination, hematological and biochemical parameters, barium studies, upper gastrointestinal endoscopy, Endoscopic biopsy and computerised tomography. All deserving patients were explored with the basic intent of resection, even as a palliative measure. Patients however, found unresectable were subjected to palliative by pass. Following surgery, histopathological examination of resected specimens, tumor morphology, differentiation, clearance of cut margins and level and status of lymphnodes studied. Post operative adjuvant chemotherapy was given to patients, who after resection showed, involvement of lymphnodes, microscopic invasion of the cut margins, unfavorable histology and differentiation and presence of lymphatic or angio - invasion. Palliative chemotherapy was given to patients having unresectable disease. Patients were followed up till the time of discharge from hospital. Post operative complication during the hospital stay were recorded. SUMMARY AND CONCLUSIONS: 1. Gastric adeno carcinomas most commonly occurred between 4th and 5th decades, which is one or two decades earlier, when compared with Western countries and Japan. Male - Female ratio is 3.5 : 1.5. Farmers and labourers belonging to low socio economic group and patients with blood group `A' are more susceptible to the disease. 2. Strong association exists with smoking, alcohol, spicy and salted foods and high starch diet. Vegetables and fruits are associated with low incidence of gastric cancer. 3. Our patients present very late with obstruction, tumor fixation and extragastric spread, when compared to patients abroad. 4. Gastroscopy with biopsy, seems to be the most important investigation in the diagnosis of gastric cancer, with an accuracy 98% Barium meal has important role to play only in certain group of patients like linitis plastica, lymphomas and gastric stasis. 5. The most common site of growth still in India is the Antrum followed by Body, but proximal stomach cancers seem to be increasing compared with previous studies. 6. The most common type of growth is ulcerative type with everted margins (Type II Borrmann). Diffuse type is the least common. 7. Most of our patients presented late with advanced disease amenable only for palliative resection or palliative by pass procedures. 8. Only a few patients underwent D1 type curative resection with histopathology showing tumor free margins. 9. Most of the tumor showed well differentiated mucinous type of adenocarcinoma which had good prognosis. 10. Wound infections and respiratory infections were the most common postoperative complications. 11. Early gastric cancer has a high percentage of curative resection rate but because of ineffective screening procedures the detection of early gastric cancer is almost nil. Gastric Malignancy present us with many challenges. Even with the best surgical care available today, the advanced malignancy of stomach which we encounter will yield only poor results. EARLY DIAGNOSIS, FULLY DEVELOPED PREOPERATIVE STAGING AND AN AGGRESSIVE SURGICAL APPROACH PROVIDE THE BEST HOPE OF IMPROVING THE OUTLOOK FOR PATIENT WITH GASTRIC CANCER